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Docket / Court 5:04-cv-76 ( E.D. Ky. )
State/Territory Kentucky
Case Type(s) Nursing Home Conditions
Attorney Organization U.S. Dept. of Justice Civil Rights Division
Case Summary
Pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, the Civil Rights Division of the U.S. Department of Justice ("DOJ") conducted an investigation of conditions at the Nim Henson Geriatric Center ("Henson"), a county-operated skilled nursing facility in ... read more >
Pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, the Civil Rights Division of the U.S. Department of Justice ("DOJ") conducted an investigation of conditions at the Nim Henson Geriatric Center ("Henson"), a county-operated skilled nursing facility in Jackson, Kentucky. The investigation resulted in a findings letter being sent to Breathitt County's judge executive on March 6, 2003. The letter stated that in June 2002, DOJ and certain of its expert consultants toured the facility, interviewed administrators, residents and staff, and reviewed medical and other records. The DOJ's investigation led it to conclude that certain conditions at Henson violated residents' federal constitutional and statutory rights. According to the DOJ, residents at Henson suffered from deficiencies in the following areas: 1) general medical care, 2) chemical restraints, 3) wound and nutritional care, 4) restorative care, 5) psychiatric care, and 6) incident management and quality assurance.

The findings letter described that the DOJ investigators determined that the facility's medication management practices; its medical notes and documentation; and its oversight and management of medical care did not meet generally accepted standards of care. Among the identified systemic deficiencies were unjustified use on residents of polypharmacy and psychotropic medications, inadequate monitoring of medications' effects, and failure to re-evaluate the continued necessity or dosage units of certain drugs. The investigation found poor or absent (i) physician-pharmacist consultations, (ii) medication policies and guidelines, (iii) diagnosis and treatment of underlying disorders (rather than symptoms), (iv) medical notes and documentation, and (v) oversight and management of medical care.

The facility employed sedation for reasons not associated with a medical condition, and the intermediate care unit within the facility provided substandard wound assessment, identification, care and tracking. Failure to appropriately respond to instances of weight loss and overuse of feeding tubes reflected poor nutritional care at the facility. Henson's failure to provide active (as opposed to passive) group activities, an absence of functional furniture, and care plans that failed to include restorative interventions addressing preventable declines in residents' functioning were other shortcomings described in the findings letter. Particularly in the intermediate care unit, DOJ found that the nursing staff lacked a systematized approach to resident assessment and to the provision of early intervention regarding significant changes in resident status. Additionally, at least half of the residents sampled were receiving psychiatric care that substantially departed from generally accepted standards. No psychiatric and no behavioral professionals were available to the facility; physicians and nurses at the facility had no training in geriatric psychiatry generally, or in treating individuals experiencing dementia or depression; and residents who badly needed acute psychiatric care were rarely transferred to psychiatric hospitals. Henson's incident management efforts failed to pull relevant disciplines together to identify and provide needed supports and services to prevent falls and injuries. Likewise, the facility lacked an effective quality assurance system to track significant trends and events and ensure that proper corrective action occurs. Regarding discharge planning, the DOJ found that Henson's staff did not adequately evaluate or assess residents for their discharge potential. It failed to have its treatment professionals periodically assess whether community-based treatment was appropriate. These latter inadequacies violated the Americans with Disabilities Act-imposed obligation to treat residents in the most integrated setting appropriate to their individual needs. See 42 U.S.C. § 12132 and 42 C.F.R. § 35.139(j).

The DOJ findings letter proposed remedial actions to remedy the multiple deficiencies, invited the county to address the issues, and alerted the county to the possibility of a CRIPA lawsuit brought by the United States to compel remedial action.

On February 17, 2004 the United States filed a complaint against Breathitt County, Kentucky, and Breathitt County Geriatric Corporation for violating CRIPA, 42 U.S.C. §1997, within the Nim Henson Nursing Home for the violations noted in the findings letter above. Specifically, the complaint alleged that the defendants failed to protect residents from harm and, further, failed “to provide adequate medical, nursing, nutritional, wound, restorative, and psychiatric care to residents” in the nursing home. Moreover, the complaint alleged that the defendants failed to continually assess whether the treatment needs of residents were being met.

On February 19, 2004, a settlement agreement was entered with the court. Through the settlement agreement the parties agreed to the following terms: Defendants would ensure that residents shall be promptly assessed, diagnosed, treated, monitored, and, when necessary, reassessed, diagnosed, and treated with current, generally accepted standards of care, including documentation adequate to withstand clinical scrutiny. Defendants would develop policies to fully monitor medication distribution, and the effects of medications on patients. Defendants would keep accurate, current, complete, and organized medical documentation. Defendants would cease using restrictive controls and chemical restraints except in narrow situations. Defendants would create and maintain a documentation system, as well as a formulary, for patient wound care. Furthermore, defendants would ensure that nurses knew “the wound status of each resident in their care.” Defendants would monitor the weight and nutrition of residents and ensure that necessary interventions occurred. Defendants would ensure residents are able to have the highest quality of life possible and develop a restorative care plan for all residents. Defendants would provide necessary psychiatric care for residents. Defendants would investigate and follow up on all “unusual incidents” or incidents involving injury. Defendants would routinely assess residents to see if community placement is necessary. Defendants would provide the United States Department of Justice with status report within 90 days and provide continual, unrestricted access to buildings and facilities, staff, residents, and records relating to the settlement agreement, staff, or residents

Two years after the settlement agreement, the government found that the Nim Henson Nursing Home had been complying with all the terms of the settlement agreement. As a result, the case was dismissed.

Mike Fagan - 06/19/2008
Cianan Lesley - 10/22/2017

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Issues and Causes of Action
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Benefit Source
Content of Injunction
Reasonable Accommodation
Hospital/Health Department
disability, unspecified
Integrated setting
Mental impairment
Mobility impairment
Food service / nutrition / hydration
Habilitation (training/treatment)
Incident/accident reporting & investigations
Individualized planning
Informed consent/involuntary medication
Neglect by staff
Reassessment and care planning
Restraints : chemical
Staff (number, training, qualifications, wages)
Totality of conditions
Medical/Mental Health
Bed care (including sores)
Medical care, general
Medication, administration of
Mental health care, general
Wound care
Plaintiff Type
U.S. Dept of Justice plaintiff
Type of Facility
Causes of Action Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seq.
Defendant(s) Nim Henson Geriatric Center
Plaintiff Description Plaintiff is the United States of America through the Department of Justice.
Indexed Lawyer Organizations U.S. Dept. of Justice Civil Rights Division
Class action status sought No
Class action status outcome Not sought
Filed Pro Se No
Prevailing Party Plaintiff
Public Int. Lawyer No
Nature of Relief Injunction / Injunctive-like Settlement
Source of Relief Litigation
Form of Settlement Court Approved Settlement or Consent Decree
Order Duration 2004 - 2006
Filed 02/17/2004
Case Closing Year 2006
Case Ongoing No
Additional Resources
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  Review of the Use of Monitors in Civil Settlement Agreements and Consent Decrees Involving State and Local Government Entities
U.S. Department of Justice
Date: 9/13/2021
By: Attorney General Merrick Garland and Assoc. AG Vanita Gupta (U.S. Department of Justice)
[ Detail ] [ PDF ] [ External Link ]

  An Analysis of CRIPA Findings Letters Issued to Jails for Constitutional Violations by the Department of Justice
Date: Apr. 15, 2016
By: Jeff Mellow, Bryce E. Peterson & Mijin Kim (John Jay College of Criminal Justice Faculty)
Citation: Am. J. Crim. Just. (April 2016)
[ Detail ] [ External Link ]

Court Docket(s)
E.D. Ky.
NH-KY-0002-9000.pdf | Detail
Source: PACER [Public Access to Court Electronic Records]
General Documents
not recorded
Re: Nim Henson Geriatric Center
NH-KY-0002-0003.pdf | Detail
E.D. Ky.
Complaint [ECF# 1]
NH-KY-0002-0001.pdf | Detail
Source: PACER [Public Access to Court Electronic Records]
E.D. Ky.
Settlement Agreement [ECF# 2]
NH-KY-0002-0002.pdf | Detail
Source: PACER [Public Access to Court Electronic Records]
show all people docs
Judges Forester, Karl Spillman (E.D. Ky.) show/hide docs
NH-KY-0002-0002 | NH-KY-0002-9000
Plaintiff's Lawyers Ashcroft, John (District of Columbia) show/hide docs
Clay, Marianna Jackson (Kentucky) show/hide docs
Johnson, Elizabeth (District of Columbia) show/hide docs
NH-KY-0002-0002 | NH-KY-0002-9000
Patel, Shennie (District of Columbia) show/hide docs
Tayloe, Benjamin O. (District of Columbia) show/hide docs
NH-KY-0002-0002 | NH-KY-0002-9000
Van Tatenhove, Gregory Frederick (Kentucky) show/hide docs
NH-KY-0002-0002 | NH-KY-0002-9000
Defendant's Lawyers Miller, Brendon (Kentucky) show/hide docs
NH-KY-0002-0002 | NH-KY-0002-9000
Other Lawyers Warrix, Lewis H. (Kentucky) show/hide docs

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